Rehabilitation after flexor tendon repair and others: a safe and efficient protocol

2021 ◽  
pp. 175319342110371
Author(s):  
Jin Bo Tang
Keyword(s):  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
Exercise Session ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Working Principle ◽  
Finger Motion ◽  
Early Passive ◽  
Number Of Cycles

In this review I detail the protocol that I use after flexor tendon repair and outline my experience regarding how its framework might be used for other disorders. The early passive–active flexion protocol has a sufficient number of cycles of active flexion in each exercise session, which is at least 40, and ideally 60 to 80. The frequency of exercise sessions may range from 4 to 6 a day, distributed in the morning, afternoon and evening. Increasing the number of daily sessions without a sufficient number of runs in each session is ineffective. In the first 2–3 weeks after surgery, active digital flexion should go through only a partial range. In weeks 4–6, the patient gradually moves through the full range. With modifications, I suggest generalization of the partial-range finger motion to therapy after treating other hand injuries. I consider partial-range active flexion a generalizable working principle for different hand disorders.

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion

2018 ◽  
Vol 44 (4) ◽  
pp. 354-360 ◽  
Author(s):  
Koji Moriya ◽  
Takea Yoshizu ◽  
Naoto Tsubokawa ◽  
Hiroko Narisawa ◽  
Yutaka Maki
Keyword(s):  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV

Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C

2016 ◽  
Vol 41 (8) ◽  
pp. 822-828 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
K. Hara ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Clinical Results ◽  
The Other ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
A2 Pulley ◽  
Active Mobilization ◽  
Finger Motion

We report the results of complete release of the entire A2 pulley after zone 2C flexor tendon repair followed by early postoperative active mobilization in seven fingers and their comparisons with 33 fingers with partial A2 pulley release. In seven fingers, release of the entire A2 pulley was necessary to allow free gliding of the repairs in five fingers and complete release of both the A2 and C1 pulleys was necessary in two. No bowstringing was clinically evident in any finger. Two fingers required tenolysis. Using Tang’s criteria, the function of two digits was ranked as excellent, four good and one fair; there was no failure. The functional return in these seven fingers was similar with that in 33 fingers with partial A2 pulley release; in these patients only one finger required tenolysis. Our results support the suggestion that release of the entire A2 pulley together with the adjacent C1 pulley does not clinically affect finger motion or cause tendon bowstringing, provided that the other pulleys are left intact. Level of evidence: IV

The Effect of Delay to Surgery on Major Complications after Primary Flexor Tendon Repair

2019 ◽  
Vol 24 (02) ◽  
pp. 161-168 ◽  
Author(s):  
Aleksi Reito ◽  
Mari Manninen ◽  
Teemu Karjalainen
Keyword(s):  
Flexor Tendon ◽  
Multivariable Analysis ◽  
Tendon Repair ◽  
Significant Risk ◽  
Mechanism Of Injury ◽  
Flexor Tendon Repair ◽  
Major Complications ◽  
Increased Risk ◽  
Early Passive ◽  
Surgery Delay

Background: Flexor tendon repair carries a significant risk for complications, which often leads to revision surgery. The purpose of this study was to assess the effect of different factors on the risk for major complications patients undergoing a primary end-to-end flexor tendon repair and early passive mobilization regimen (Kleinert protocol). Methods: Between January 2000 and September 2009, a total of 312 patients underwent a flexor tendon repair at out institution. We excluded patients whose injury was self-inflicted or secondary to a rheumatic disease or a fall leaving 187 patients with 325 injured tendons for the study. Results: 152 (81.7%) patients were male and 34 (18.3%) females. Mean age of the patients was 32.7 years (SD 14.4, range 11 to 73). The fifth ray was most commonly affected. The majority of the injuries were located in zone II. Median delay to surgery was 3 days. Complications were observed in 34 patients (18.2%). Univariable analysis showed that patient age, mechanism of injury, injured ray, delay to surgery between three and seven days, and greater suture thickness were associated with increased risk of complications. In the subsequent multivariable analysis, only the mechanism of injury and delay to surgery remained as significant risk factors for major complications. Conclusions: We conclude that complications after flexor tendon repair may be reduced by appropriate timing of the surgery. Delay to surgery lasting between three and seven days seems to be associated with increased risk for major complications.

Flexor Tendon Repair Using a Stainless Steel Internal Anchor

1998 ◽  
Vol 23 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. GORDON ◽  
M. TOLAR ◽  
K. T. VENKATESWARA RAO ◽  
R. O. RITCHIE ◽  
S. RABINOWITZ ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Active Range Of Motion ◽  
Flexor Digitorum

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99–270% increase in mean maximal linear tensile strength and a 49–240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Strong Digital Flexor Tendon Repair, Extension-Flexion Test, and Early Active Flexion

Hand Clinics ◽  
2017 ◽  
Vol 33 (3) ◽  
pp. 455-463 ◽  
Author(s):  
Jin Bo Tang ◽  
Xiang Zhou ◽  
Zhang Jun Pan ◽  
Jun Qing ◽  
Ke Tong Gong ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Flexion Test

LENGTHENING THE LOCKING LOOP REPAIR FOR ZONE 2 FLEXOR TENDON LACERATION AND PARTIAL LATERAL RELEASE OF THE TENDON SHEATH

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 125-129 ◽  
Author(s):  
Hithoshi Hatanaka ◽  
Tetsuo Kojima ◽  
Tomoyuki Miyagi ◽  
Tomoyuki Mizoguchi ◽  
Yoshifumi Ueshin
Keyword(s):  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Lateral Release ◽  
Flexor Tendon Repair ◽  
Loop Technique ◽  
Tendon Laceration

The authors present the clinical outcomes of nine zone 2 flexor tendon repairs using a locking loop technique (i.e. the Modified Pennington technique). The locking loops were located approximately 10 mm away from the lacerated tendon ends to "lengthen" the locking loop repair, as experimentally and clinically recommended. The partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, was performed not only to locate the sutures but also to allow a full range of motion of the repair without catching on the tendon sheath, as clinically recommended. All the patients were followed up for six months or more except for one. All digits were evaluated as excellent or good at the final follow-up by the original Strickland criteria. No rupture occurred and no bowstring of the flexor tendon was observed. The clinical outcomes of the current study indicate that "lengthening" the locking loop repair is effective for zone 2 flexor tendon repair and that the partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, does not result in the bowstring of the flexor tendon.

Outcomes of the six-strand M-Tang repair for zone 2 primary flexor tendon repair in 54 fingers

2017 ◽  
Vol 42 (5) ◽  
pp. 462-468 ◽  
Author(s):  
X. Zhou ◽  
X.R. Li ◽  
J. Qing ◽  
X.F. Jia ◽  
J. Chen
Keyword(s):  
Full Range ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
A2 Pulley ◽  
Male Patients ◽  
Early Passive ◽  
One Year

We repaired complete divisions of flexor tendons in zone 2 in 54 fingers using a six-strand core M-Tang repair method. Partial active digital motion started with early passive digital motion carried out first in the first 3–4 weeks after surgery and full range of active motion in later weeks. The patients were followed for 4–27 months. According to Strickland criteria or Tang criteria, 24 (83%) had excellent or good, four fair and one poor results in 28 fingers with follow-up of more than one year. In the other 25 fingers which were followed for less than 12 months, 19 (76%) had excellent and good, four fair and two poor results. There were no repair ruptures. We analysed outcomes against ages, gender, pulley integrity, accompanied injuries and follow-up times. The patients younger than 37 years old, male patients and with their A2 pulley(s) vented there were significantly better outcomes. The patients with longer than one year follow-up had significantly smaller extension deficits than those with less than one year follow-up. Level of evidence: IV

SPLINTING FLEXOR TENDON INJURIES

Hand Surgery ◽  
2002 ◽  
Vol 07 (01) ◽  
pp. 101-108 ◽  
Author(s):  
Elaine Ewing Fess
Keyword(s):  
Classification System ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Early Passive

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the Amercian Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

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